Iqbal Sonia, Wan Wing Y, Mitchell Natalie E
Department of Internal Medicine, Brooke Army Medical Center, Fort Sam Houston, USA.
Department of Endocrinology, Mike O'Callaghan Military Medical Center, Nellis Air Force Base, USA.
Cureus. 2022 May 26;14(5):e25355. doi: 10.7759/cureus.25355. eCollection 2022 May.
Nephrotic syndrome can result in worsening of existing hypothyroidism in patients requiring thyroid hormone supplementation. The urinary loss of thyroxine-binding globulin, as well as increased gut edema, likely lead to reduced absorption and retention of exogenous thyroid hormone. Here, we present a case of a patient with Hashimoto's thyroiditis, previously well-controlled on levothyroxine, who developed symptomatic hypothyroidism as a result of newly diagnosed nephrotic syndrome, whose symptoms improved with transition to an alternative formulation of levothyroxine and treatment of her underlying nephrotic syndrome. It is important to consider nephrotic syndrome as a cause of worsening hypothyroidism in a patient on a fixed dose of levothyroxine given the potential morbidity associated with a missed diagnosis and often need for escalation of dosage. There is no standardized therapy for hypothyroidism exacerbated by nephrotic syndrome, but liquid or gel formulations of levothyroxine may be more effective in patients with absorption problems.
肾病综合征可导致需要补充甲状腺激素的患者现有的甲状腺功能减退症恶化。甲状腺素结合球蛋白的尿丢失以及肠道水肿加重，可能导致外源性甲状腺激素的吸收和潴留减少。在此，我们报告一例患有桥本甲状腺炎的患者，该患者之前服用左甲状腺素病情控制良好，但由于新诊断的肾病综合征而出现症状性甲状腺功能减退，其症状在改用左甲状腺素的替代制剂并治疗其潜在的肾病综合征后得到改善。鉴于漏诊可能带来的发病率以及通常需要增加剂量，在服用固定剂量左甲状腺素的患者中，将肾病综合征视为甲状腺功能减退症恶化的原因很重要。对于因肾病综合征而加重的甲状腺功能减退症，目前尚无标准化治疗方法，但左甲状腺素的液体制剂或凝胶制剂可能对有吸收问题的患者更有效。
